GLP-1 utilization has surged, driving increased pharmacy spending and forcing employers to make difficult decisions. How do you provide access to in-demand and potentially valuable treatments while keeping your health plan affordable and sustainable?
Heading into the next round of health plan renewals, GLP-1 coverage has become a critical cost issue. But simply covering or excluding GLP-1s may be the wrong choice.
H2B and AlignWell are taking a different approach: offering a turnkey solution that redesigns the benefit around the medication, and can reduce GLP-1-related costs by more than 40%.
What Are GLP-1 Medications?
GLP-1 drugs are a class of medication used to help people with type 2 diabetes manage blood sugar levels. Some GLP-1 medications have also proven effective at treating obesity and have become popular for weight management. Available medications include well-known brands such as Ozempic, Wegovy, Mounjaro and Zepbound.
“If you’re seeing high demand for GLP-1s, this isn’t a one-time spike – it’s a signal that some members are metabolically unwell, and it’s a trend that could affect your health plan for the next three to 10 years,” explains AlignWell founder and CEO, Dr. Andrew White.
Because there are different medication options, and they may be used to treat different conditions, GLP-1 coverage is not a simple yes-or-no decision. An employer that opts not to cover GLP-1s for weight loss may still cover GLP-1s for diabetes or other approved conditions. Employers that provide weight-management coverage can also establish eligibility requirements, utilization controls and clinical-support requirements.
Why GLP-1s Are Getting Employers’ Attention
A 2026 Gallup survey found that 11% of U.S. adults report using GLP-1 drugs for weight loss in 2026, up from just 3% in 2024. As more and more people use GLP-1s, demand for coverage under employer-sponsored health plans has also increased. Mercer says that 49% of large employers covered GLP-1 medication for weight loss in 2025.
“GLP-1s have high perceived value, and therefore they represent an opportunity to build benefit plans that attract and retain talent,” White says. “Most benefits cost the employer ten dollars and feel like one dollar to the employee. Set up correctly, a GLP-1 benefit flips that: it costs a dollar and feels like ten. That’s how you attract and keep talent, at a discount.”
The challenge is figuring out how to set it up correctly.
According to a 2026 Business Group on Health survey, nearly eight in 10 employers say that GLP-1 drugs are contributing to an increase in their health care costs, and 10% of companies that offer GLP-1 coverage for weight management say they probably won’t continue to do so in 2027. But eliminating coverage isn’t the only way to control the cost.
How GLP-1 Utilization Can Affect Health Plan Costs
With GLP-1 utilization rising, the cost can add up quickly. Higher pharmacy claims can contribute to overall plan costs, potentially putting greater pressure on renewal rates, employee cost-sharing or other plan elements.
The pressure is already visible in the broader health insurance market. According to the Peterson-KFF Health System Tracker, the median proposed premium increase for ACA-compliant small group coverage in 2027 is 14%, based on 295 small group insurers across all 50 states and the District of Columbia.
GLP-1 utilization is only one factor. Rising medical prices and utilization, high-cost specialty drugs, biologics and other prescription drug spending are also contributing to higher costs. But GLP-1s have become significant enough that employers can no longer treat them as just another pharmacy line item.
The bigger question is whether employers can change the economics.
AlignWell + H2B: Changing the GLP-1 Equation
The potential savings aren’t based on a single case. Across 39 self-funded employer groups analyzed, representing 235 members on GLP-1 therapy, AlignWell modeled $1.77 million in annual plan savings.
Consider one employer AlignWell recently analyzed, a 300-employee company with 26 members on GLP-1 therapy. Prior to the AlignWell + H2B solution, the plan paid $363,000 in annual pharmacy spend, not including the additional expense of treating members’ related chronic conditions. Members were also paying copays for their medications and care.
Now, this same plan is able to provide full supportive care to GLP-1 users at a savings of roughly $638 per GLP-1 member per month compared to what they used to pay for GLP-1 prescriptions only.
| 300-Employee Plan with 26 Members using GLP-1 Therapy | Old Way | AlignWell+H2B Solution | Savings |
|---|---|---|---|
|
GLP-1 RX |
$363,000 |
$164,000 |
$199,000 |
|
Chronic care Treatment |
-Member driven -Extra cost |
-Labs, primary care visits, behavioral health support and hands-on musculoskeletal care included with the GLP-1 solution. -No added cost. |
Significant |
|
Member copay |
Members paid copays for their medications and care. |
No copays for most members. Members on HSA-qualified plans pay a fair-market amount until their deductible is met, as IRS rules require. |
Varies |
|
Outcome-driven approach |
Paid for GLP-1 with no off-ramp or outcome tracking. |
Employer can choose the off-ramp and outcome tracking. |
Better positioned for long-term improvement. |
Plan Structure Matters: A Prescription Is Not a Health Strategy
Increasingly, employers are putting more structure around GLP-1 coverage. The 2026 Business Group on Health survey found that employers are using strategies such as biometric eligibility requirements, participation in weight-management programs, restrictions on who can prescribe GLP-1s and formulary controls to encourage appropriate use.
AlignWell takes that idea further by surrounding the medication with the care and support members may need to get more value from treatment. White compares GLP-1s to a race car: They’re powerful, but most people have never driven one. Simply handing over the keys without instruction or guardrails may not produce the desired result. That’s the thinking behind the GLP-1 solution available to H2B employers through AlignWell.
The employer determines how the GLP-1 program is structured. For example, an employer can choose to:
- Offer the program for chronic condition management and/or for obesity management.
- Cover 100% of GLP-1 costs for a defined period, only for members who participate in certain health activities and ROI tracking.
- Build a comprehensive program to support objectives, which may include primary care visits, behavioral health services, musculoskeletal care, nutritional counseling, monthly weigh-ins and outcome tracking.
Employers can also build a structured six- to 12-month off-ramp into the benefit rather than treating GLP-1 therapy as an indefinite prescription expense. Monthly hands-on weigh-ins and ROI tracking help measure progress while members receive the clinical support they need to build healthier habits and address underlying conditions.
In White’s racecar analogy, the member still gets the keys. They also get driving lessons and guardrails.The objective is to use the period of GLP-1 treatment to help members address underlying health issues, develop healthier habits and potentially improve longer-term outcomes.
That philosophy is central to AlignWell’s approach to health care: engaging employees through provider relationships and giving them health mentors and accountability partners rather than expecting them to navigate their health on their own.
“For self-insured plans, the financial impact is immediate,” White says. “In just one month after starting the program, the plan will have spent significantly less than the previous month, and they have money to put back into their plan.”
GLP-1 Coverage: Cost Today vs. Potential Value Tomorrow
Is it simpler to just stop covering GLP-1s? Perhaps. But the direct cost of the medication is only one side of the equation.
GLP-1 medications have demonstrated benefits for chronic conditions and obesity management. Over time, improving members’ health could potentially reduce costs associated with these conditions. GLP-1 coverage may also have value as an employee benefit, particularly when workers increasingly expect access to these treatments.
That’s what makes the decision difficult. Employers can see the pharmacy claim today. The potential health and financial benefits that may materialize years from now are much harder to quantify. In fact, Business Group on Health found that while more than half of employers covering GLP-1s for weight management expect significant clinical benefits, few have yet seen evidence of those benefits in their aggregate claims data.
Simply dropping coverage may reduce pharmacy spending, but it could also affect employees who are already receiving treatment and create higher out-of-pocket costs for workers who continue taking the medications.
Instead, employers can evaluate GLP-1 coverage as part of their overall benefits ecosystem. Depending on their goals and plan structure, strategies may include eligibility requirements, utilization management, alternative sourcing arrangements and clinical-support programs.
In other words, the decision doesn’t have to be covering GLP-1s at any cost or not covering them at all. There’s a third option: redesign the benefit.
Questions Employers Should Ask Before Their Next Renewal
The impact of GLP-1 coverage is too great to ignore. Ahead of your next renewal, assess your GLP-1 strategy by asking 12 questions.
- How much are we currently spending on GLP-1 medications?
- How quickly is utilization changing?
- Which GLP-1 indications does our plan currently cover?
- What eligibility and utilization-management requirements apply?
- How much are employees paying out of pocket?
- What is our PBM doing to manage GLP-1 costs?
- Are rebates and discounts being passed through appropriately under our arrangement?
- What clinical support accompanies coverage?
- What would happen to employees currently receiving treatment if we changed coverage?
- How would expanding, restricting or eliminating coverage affect our projected plan costs?
- How does our approach compare with relevant employers competing for the same talent?
- What alternatives should we evaluate before making a coverage decision?
Build an Eyes-Wide-Open GLP-1 Strategy
Ignoring GLP-1 utilization won’t make the cost disappear. Neither will focusing exclusively on the price of the medication.
At Health2Business, we help businesses design health plans that meet the needs of workers while controlling costs. Through our partnership with AlignWell, H2B employers can take a more comprehensive approach to GLP-1 coverage, combining access to medication with primary care, labs, nutritional guidance, behavioral health support and other services designed to help members get more value from their treatment.
Our turnkey GLP-1 solutions pass medications through at acquisition cost with zero markup. AlignWell is fully transparent regardless of source (compounded or name-brand, the employer’s choice), and directly contracts the labs, primary care, and hands-on MSK care through its network at cash rates. The program also bills through the employer’s TPA, creating transparency for the TPA and stop-loss carrier while making the solution easier to integrate into the existing plan.
“We don’t make money on the medication,” White explains. “The medication is the signal, not the problem. It’s a tool, not a strategy. We pass it through at acquisition cost with no markup, and we make our money on the care that actually changes outcomes.”
The goal isn’t simply to pay less for GLP-1s. It’s to turn GLP-1 spending into a health strategy.
To learn more about our turnkey GLP-1 cost-containment solution, contact Health2Business.
